Clinical and diagnostic features of tissue perfusion disorders in wounded patients with combat-related combined cold thermomechanical limb injuries

The simultaneous occurrence of firearm injury, low-temperature exposure, blood loss, and tourniquet application complicates assessment of tissue viability during the early hospital period and requires the use of modern methods for regional hemodynamic evaluation. Aim. To determine the clinical and diagnostic features of systemic and regional perfusion disorders in wounded patients with combat-related combined cold thermomechanical limb injury during the acute period of traumatic disease. Materials and methods. A prospective clinical study enrolled 111 wounded servicemen with combat-related combined cold thermomechanical limb injury treated at a Level II medical care facility between 2022 and 2025. Systemic hemodynamic parameters, severity of hypothermia, laboratory signs of tissue hypoxia, metabolic disturbances, local clinical manifestations of limb injury were assessed. Ultrasound Doppler examination and infrared thermography (IRT) were used to evaluate regional hemodynamics and tissue perfusion. Results. Severe or extremely severe condition was recorded at admission in 104 (93.6 %) wounded. Body temperature below 35 °C was registered in 77 (69.4 %) cases. Arterial hypotension was detected in 48 (43.2 %), tachycardia exceeding 100 beats/min in 79 (71.2 %), and oliguria in 46 (41.4 %) cases. Mean blood lactate level was 3.6 ± 1.9 mmol/L. Clinical signs of impaired peripheral perfusion, including pallor, cyanosis, local hypothermia, and sensory disturbances, were identified in most patients. Severe venous outflow disorders were detected by Doppler ultrasonography in 46 (59.0 %) critically ill individuals. IRT demonstrated reduced surface temperature of the injured limb in 79 of 86 (91.9 %). Conclusions. Combat-related combined cold thermomechanical limb injury is associated with severe systemic and regional perfusion disorders. The combined use of Doppler ultrasonography and infrared thermography enables objective assessment of ischemic tissue changes and supports clinical decision-making in the management of cold ischemic limb injuries in the combat setting.